28 February 2003
Heart disease risk factors should be treated aggressively in rheumatoid arthritis (RA) patients following new evidence of their elevated risk of myocardial infarction (heart attack), Heart Foundation spokesman Professor Andrew Tonkin said.
Data from the US Nurses' Health Study have shown women with RA had twice the risk of heart attack but no increased risk of stroke, compared to those without the condition (Circulation 2003; 107: 1297-1301).
‘This study does suggest a real association between rheumatoid arthritis and coronary disease, and it means we need to be aggressive about attention to coronary risk factors,’ Professor Tonkin said.
‘Whether or not the aggressive treatment of rheumatoid arthritis is going to decrease the coronary events is speculative.’
Some data suggested methotrexate (a medication used to treat RA) may be protective against heart disease in RA, he said.
Dr Jim Bertouch, chair of the Australian Rheumatology Association's therapeutics committee, said the findings confirmed earlier studies suggesting a link between RA and cardiovascular disease.
However, this particular study lacked vital data on the types of therapy — such as corticosteroids and NSAIDs (non-steroidal anti-inflammatory drugs) — that women were taking, which might have shed light on whether controlling inflammation reduced myocardial infarction (MI) risk.
The risk of MI remained after taking into account smoking, elevated cholesterol, hypertension and diabetes (all of which are other risk factors for heart disease).
‘It suggests something else is going on, and that the risk is not related to traditional risk factors,’ Dr Bertouch said.
He said he was wary of drawing too many conclusions from such small numbers, particularly as they were confirmed by review of medical records rather than by physical examination.
The study involved a group of more than 114,000 women aged 30 to 55 years who were free of cardiovascular (heart and blood vessel) disease and rheumatoid arthritis at baseline (that is, at the start of the study period).
Nearly 8000 women who reported RA over a 20-year period were followed up, with 527 cases of RA confirmed.
The adjusted relative risk of MI in women with RA compared with those without was 2.0, and in those who had rheumatoid for at least 10 years it was 3.10, leading the authors to conclude it would be prudent to consider cardioprotective measures.
Relative risk is the ratio of risk of disease (for example, heart attack) among people exposed to a risk factor (for example, rheumatoid arthritis) to the risk of this disease among people not exposed to the risk factor. So, here women with RA have twice the future risk of having an MI compared to women of average health without RA, and those women with RA for at least 10 years have 3.10 times the future risk of having an MI compared to women of average health without RA.
Last Reviewed: 02 March 2003